Why patients will reject evidence-based medicine

Newsweek’s Sharon Begley pens an excellent piece on why Americans will reject evidence-based medical decisions.

She opens with a vignette, which every emergency physician should be familiar with:

A 4-year-old suffers minor head trauma, perhaps from falling off a swing and hitting her head on the ground. She is dazed, and although she doesn’t lose consciousness her worried parents—visions of subdural hematomas and concussion dancing in their own heads—rush her to the local emergency room, expecting that the doctors there will immediately do a CT scan.

The data, however, suggests that a head CT will not improve care in these cases, and, “in more than 99.9 percent of the cases, the rules accurately predicted which ones did not have a serious brain injury and could therefore have skipped the CT.”

But American patients tend to obsess about that 0.1 percent where the rules missed a serious brain injury.

Ms. Begley rightly sums up that sentiment: “Americans believe that there is no such thing as too much treatment. That, of course, ignores the fact that few treatments are without risk and that every time the medical system gets its hands on you there is another possibility of medical error.”

There is a fundamental belief in our society that more medicine equals better care. But that’s not always the case. Progressive health reformers tend to single out medical providers as the driving force behind ordering more tests. And with all the incentives within the health system favoring more tests and treatments, that’s partially true.

But they need to acknowledge that patients need to shoulder some of that blame too.


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